Stop patient handoff, consultant says
Think “hotel,” rather than “hospital,” when it comes to taking care of your patients. That’s the No. 1 piece of advice offered to access managers by Patti Daniel, MS, CCM, LPC, LMSW/AP, director of patient advocacy and entitlement solutions at Healthcare Management Solutions in Dallas.
While many hospitals are moving in that direction, notes Daniel, a former director of admissions and registration at a large, publicly funded Texas hospital, most haven’t gone far enough. “Trends are to make it easier for patients to register themselves, to make appointments or change them, and to know in advance what their time of service payment will be,” she explains. “Those are the kinds of things you see hotels doing. The customers have a reservation, they know what the anticipated charge is going to be, and all they have to do is hand over a credit card and check in,” Daniel adds.
At most hospitals, there is still a handoff of the patient from scheduling to insurance verification and check-in, she points out. “It’s easier in some facilities and not so easy in others. The bigger the organization, the more disjointed it becomes for the patient. We need to make it a more seamless process and less difficult for patients by anticipating what would make things easier for them,” Daniel explains.
Are your patients still waiting in line?
If you’re a patient at a hospital today, what’s probably not happening, she notes, is the following: You walk up to a kiosk in the lobby area, swipe your credit card, hospital ID card, or driver’s license. The magnetic strip picks up who you are, identifies your appointment location, and checks you in without delay.
More likely, Daniel says, you’re waiting in line at the registration desk, and there’s a problem with the registration of the person in front of you that’s slowing things down. “This happens especially in large teaching hospitals where there are hundreds of people checking in for appointments who wait for hours,” she adds, “simply because the check-in process is antiquated, coupled with overbooking of appointments and waiting on physicians.
“Even if you make the appointment, preregister the patient, verify insurance, and precert the visit,” Daniel notes, “they still have to contend with lines that could be streamlined by the use of electronic check-in methods.”
Referencing another industry from which hospitals could take a lesson, she points out that before going to the airport to catch a flight, she is able to print a boarding pass at home that allows her to board the airplane in the first segment of passengers. “If I wait until I get there, I have to stand in line and, chances are, board with the last group,” Daniel adds.
Also on that visit to the airport, she has the option of sliding a credit card into the reader at a kiosk where a security document prints out. With that document, Daniel says, she can skip one episode of standing in line. “There are varying degrees of what can be allowed [during a patient encounter], but we should at least have check-in be a smoother process,” she adds.
Give patients more tech tools, save money
Giving more control to patients — some of whom have the technical savvy to check themselves in easily via electronic means — could result in salary savings for hospitals, she notes. Although there always will need to be patient advocates to assist those who cannot use the Internet or electronic check-in kiosks, Daniel adds, fewer employees would be needed if even some patients can make or change their own appointments.
Continuing her discussion of “the way things should go” at hospitals looking to become more customer-friendly and more competitive, Daniel offers several suggestions:
• Allow patients to make appointments on-line, change appointments if necessary, and when they arrive, check themselves in.
“There will have to be some mechanism for patients to give their consent, but there are now electronic means to perform signatures on computer notepads,” she adds. At least one large Dallas hospital is looking at the use of electronic signatures for patient consent forms, Daniel notes, as well as an easier check-in process through the use of electronic check-in kiosks that also will provide maps to appointment locations.
• To improve upfront collections, hospitals need to be much better at telling patients what they should be prepared to pay.
Access personnel should be able to give patients an estimate of what their charges will be that day, while emphasizing that the figure is an estimate, Daniel says, and doesn’t include the cost of any additional tests the physician might order. Providing the amount of charges in advance for scheduled patients, she adds, will avoid the embarrassment of “I don’t have that much in my checking account” or “If I had known that, I would have brought my credit card,” and result in higher point-of-service collections.
Real-time on-line eligibility systems that allow staff to verify third-party payers are a must, Daniel says, unless patient appointments are scheduled far enough in advance that delayed-response systems will suffice. Automated telephone systems for checking eligibility, she adds, “are antiquated compared to what is available on the web.”
• Use a concierge approach as your role model for customer service.
“Communication with patients is key,” Daniel emphasizes, and it’s not just about informing them of required fees, but about providing instructions and directions so they will be on time and won’t get lost when they have an X-ray in another building. “The more we share with them, the better patients they’ll be,” she adds.
Improve communication
Good communication skills can also help the bottom line, Daniel points out. “The key to being reimbursed in the quickest manner possible is when patient access employees do a good job of getting information from the patient up front.” When confirming a patient’s address, for example, she recommends, “May I please have your current address?” rather than, “Do you still live at 210 Main St.?” With the latter question, Daniel continues, the person may fail to hear clearly because of all the people around, or say yes without really listening or because he wants to speed up the check-in process.
• Take advantage of technology improvements.
“Enhanced technology is abounding for patient access functions,” she points out, and offers, most notably, the ability to “report well and do data mining — taking the data and being able to sort them any way possible to know more about your client base — and then to build processes that will enhance the hospital’s revenue based on those data.”
Being able to identify all the accounts with a particular third-party source,” Daniel adds, “allows the data to be mined and the reports used to forecast estimated revenue, when changes occur in reimbursement, for example.”
Knowing such information in advance leads to better management of resources, she notes. “If you can predict that reimbursement will be going down in two months, you may want to reallocate resources — adjust the number of FTEs [full-time equivalents], for example.”
• Work more closely with clinical staff, especially case managers and social workers.
“We’re all here to serve the patients and to do that in the most comprehensive and compassionate way we can,” Daniel says. “The clinical staff need to know what kind of coverage patients have. Sharing that information — what’s covered, what’s not — is the key to effective discharge planning for those case managers and social workers,” she adds. That conversation doesn’t always happen, Daniel points out.
At the hospital where she formerly worked, she developed a process whereby financial counselors notified case managers of existing or potential payers by completing a sheet and placing it on the inpatient chart immediately following the patient’s screening, Daniel explains. “The financial counselor was required to indicate — on that sheet — what the patient was eligible for, what information was pending, and what the potential third-party payer was, so the case manager could make an effective discharge,” she says.
Management support is crucial
Ultimately, the suggestions Daniel has made are all about “identifying needs and trying to meet those needs in an effort to better serve the patient,” she points out. “One thing that must happen for this to occur, is that senior management has to back up [the initiatives] and provide real support.
“For example, when a patient goes to a hospital administrator and says, ‘I want to make a complaint; I’ve never had to pay [up front] before,’ that administrator has to confirm that the copay really is $50, and then offer the person all the payment options that are available,” Daniel says.
Patients will be more accepting of making payments up front when they are informed in advance of their financial obligations, rather than being hit with a large bill when they get to the hospital or clinic, she suggests. “It’s all about providing excellent customer service, anticipating the needs of patients, and using technology to help in the process,” adds Daniel.
Think “hotel,” rather than “hospital,” when it comes to taking care of your patients.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content